L&I and Structured Settlements

Is a structured settlement of your L&I claim right for you? I know the department sends out form letters to injured workers who are at least 50 years old and have allowed claims informing them that they may be eligible for a structured settlement of their claim. What is a structured settlement, and is it in your best interest to “settle” your claim.

The Legislature called them structured settlements because you do not get the total agreed to amount in a lump sum. It is parceled out to you based on what can only be described as a weird formula. (payments of at least 25% but not more than 150% of the State’s average monthly wage – who makes this stuff up!?) The idea is the funds will provide a soft landing back into the world without L&I. In exchange for the settlement, your claim is closed with only the possibility of payment for future medical treatment if the claim is reopened. That means no future time-loss, vocational benefits, PPD or Pension awards. Is that a good idea for you?

Maybe – maybe not. There are a lot of things to consider.

What is the status  of your medical treatment? While a structured settlement leaves open the possibility of reopening your claim for medical treatment, moving forward with a settlement if you are still actively treating for your work injury is probably not a good idea. Reopening a claim for medical treatment can be an expensive proposition if there are any disputes about whether your condition has objectively worsened.

Are there disputes in your claim? There probably are, if you are being offered or are considering a Structured Settlement. Is there a sum of money for which it makes sense to walk away from those disputes? Perhaps. It depends on what the dispute is about, what you have to gain, and how much it may cost you out of pocket to litigate the issue. Do you have more to gain than lose? These are questions an attorney can help answer.

Can you support yourself without payments from L&I? Do you have a real plan to return to work, are you on Social Security Disability or Retirement? If L&I is out of the picture, can you make ends meet? You have to be honest with yourself about your financial situation. Whatever the amount of your Structured Settlement, it will be paid in full at some point, and there will be no further payments from L&I, no matter what your situation.

These are only a few of the things you should consider. Deciding to accept or negotiate a structured settlement is a big step. It may be right for some injured workers in some situations, but it is certainly not a one size fits all answer. Make sure you understand what is being offered and what you will be giving up. Ask questions. Get legal advice. Give yourself the best possible chance to make the right choice for your particular circumstances.

Significant Decisions

I’ve added a new link – but it comes with a warning. The link will take you to a subject index of Significant Decisions from the Board of Industrial Insurance Appeal.

 

I should back up.  If the Department of Labor & Industries issues a Decision and Order and you or your employer disagrees, a protest or appeal must be filed within 60 days of receipt of the Order. This magic 60 day language is on the bottom of each and every Department Order.  A protest or appeal must be in writing, a phone call will not be enough to stop the 60 day appeal period from running.

 

If you disagree with a Department Order, it is a really good time to talk to an attorney.  There are many disputes which can be ironed out without the time, expense and frustration of litigation. An attorney familiar with workers compensation may be able to help.

 

A written protest is sent to the Department, the address is on the Decision and Order. A protest is a way of asking the Department to take another look at their decision. Sometimes we call it a Request for Reconsideration. Perhaps there is additional information which was not available when the claims manager issued the order.  An additional medical report from your physician, or additional wage information may change the department’s decision if they have an opportunity to review it.  Maybe the claims manager  missed something already in the file, or took action which is not supported by the Departments records. If  a protest is filed the Department must issue a new order. They might issue a new order in as quick as a couple of days, or it may take weeks. The new Decision and Order will also have the magic 60 day appeal period language on it. Either you or the employer can file a further appeal of the order.

 

An appeal is sent to the Board of Industrial Insurance Appeals which is the administrative agency which conducts hearings on workers compensation claims.  Again, the address is on the Department’s Decision and Order. The Board has Industrial Appeals Judges who conduct mediations, hold hearings and issue what we call Proposed Decision and Orders. These decisions will be reviewed by the full Board if a Petition for Review is filed.  A decision of the full Board can be appealed to Superior Court.

 

The new link I’ve added to the blogroll will allow you to read decisions from the Board which have been designated as ‘significant’. Usually significant decisions are on issues which are, or have been, hot button topics. The Board follows the reasoning in these significant decisions when ruling on cases being heard. They will give you some understanding of the law which will be applied in your case by the Board. The Board does not have the final say on how to apply or interpret the law in workers compensation claims. This lies with our Courts. But these significant decisions give guidance as to how the Board may view a particular situation.

 

So, here’s the warning. If your workers compensation claim is at the Board, it is time to talk to an attorney.  Just because you have access to and can easily read these significant decisions does not mean you shouldn’t consult with an attorney. This is your one chance to make a record. Board hearings are like trials.  The Rules of Evidence and Superior Court Civil Rules apply. You must be familiar with these rules in order to ensure that all your testimony and evidence will be admitted at your hearing. If there is an appeal from a decision of the Board it will be decided based on the evidence and testimony present at the hearing. The Department and/or your employer will be represented by an attorney, you should be as well.

 

So, peruse the significant decisions, they are sometimes interesting reading. But if your claim has been appealed and is at the Board, don’t rely on a reading of these significant decisions to chart your course. Talk to an attorney.